Harry Bronstein, a Brooklyn mohel (ritual circumcisor) who invented the Mogen Clamp, also invented the Nutech clamp. The Mogen Clamp is a variation of the Kantor clamp. Instead of crushing the tissue by the attached hemostat, the Mogen shield acts as the clamp. It has the shortcomings of the Kantor clamp, plus one uniquely its own: with the glans below the clamp and completely out of sight, there is a chance that the tip of the glans might be caught in the clamp. Nevertheless, this is the preferred device of the more modern Jewish Mohel. It is reported to cause less discomfort when used during infant circumcision than does the Gomco Clamp.

The Mogen circumcision technique

Stretch the preputial opening.

Break preputial adhesions so that the foreskin is completely retractile, using a blunt-edged probe.

Lift the prepuce in an upward and outward direction with a hemostat. This action should cause the glans to retract towards the scrotum, preventing accidental amputation of the glans.

Place the open jaws of the Mogen clamp around the prepuce (grooved side facing the glans) and lift upwards.

Close the clamp. Affixed to a newborn, it should be left closed for one to one and one-half minutes. If the infant is more than 6 months old it should remain closed for no less than five minutes.

While the clamp is closed, excise the prepuce distal to the clamp.

Open the clamp slowly and remove it from the penis.

Apply downward pressure to the preputial skin around the corona until the skin-mucosal seal is broken and the glans is liberated.

Apply antiseptic ointment (Betadine or similar) to the crush line. Apply a light dressing or loin cloth arrangement to keep the ointment from rubbing off.

If you remove the clamp prematurely, the crushed edges may separate and bleeding will occur. In this eventuality, suture the mucocutanceous margin, being careful to avoid deep sutures that might penetrate the urethra. If the whole edge separates, treat as a freehand circumcision, placing quadrant sutures and sewing between them with fine stitches.

Have the baby watched for any sign of bleeding.

Bleeding is one of the most common complications and can also be controlled by applying gentle circumferential pressure with gauze or a sponge or by using absorbable gelatin sponge (Gelfoam), topical thrombin, epinephrine-soaked gauze or sutures.

Mogen Clamp circumcision of an infant, illustrated

There is some debate amongst religious jews concerning use of this clamp for the 8th day of life ceremony called the Bris. The crushing action of the clamp may totally prevent blood loss, contrary to the religious requirement that blood is shed.

Circumcision of an older boy

Here is a video from the Pollock clinic showing circumcision of an older boy with the Mogen clamp. Note the care taken to ensure that the glans is free.

Adult circumcision by Mogen Clamp, illustrated
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Note: This device should not be used to do a self-circumcision. Circumcision should always be performed by a trained and skilled healthcare provider.

Award of damages puts supplier out of business
In a case brought before the Fulton County Superior Court (Georgia, USA) in 2009, the Mogen Circumcision Instruments company of Brooklyn, New York, USA, was in effect put on notice that the design of the Mogen Clamp gave rise to the possibility of serious damage to the glans. Notwithstanding this and other judgements against them, they continued to supply the clamp in unmodified form and without any cautionary notice regarding its use. In a 2010 lawsuit brought in respect of a further and more serious incident, District Judge Jack B. Weinstein of the Eastern District of New York awarded damages of $10.8m against the company. In arriving at the sum awarded, Judge Weinstein was guided by a teleconference with U.S. Magistrate Judge Marilyn D. Go, who issued a report and recommendation for the amount of the damages. She noted in particular an instructional brochure accompanying the Mogen clamp stating that “no injury to glans is possible”, even though other amputations had been reported.

Mogen Circumcision Instruments did not defend the case, claiming to be unable to afford to do so. The company has ceased trading, being declared bankrupt and apparently lacking product liability insurance. It is believed that the parents settled separately and privately with the Mohel who carried out the circumcision.

It remains to be seen whether clamps of this type will remain in use. Handled properly, with due regard to the danger of the glans being drawn into the jaws of the device, the Mogen clamp appears to give rise to no greater a risk than exists with any other “tug-clamp-chop” circumcision procedure. However, it may be that negligence insurance to cover the use of such clamps will now become difficult or impossible to obtain.

The lesson to be learned here extends far beyond the subject of circumcision. Any medical procedure carries risk, something that must be acknowledged even if to do so runs contrary to the instincts of advertising and sales executives. It is interesting to speculate what the outcome in this case might have been had the clamp manufacturer bundled with their product a durable instruction card warning of the known risk and detailing the safe procedure.

Acknowledgements
The following resources were used in the preparation of this web page: